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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566215335
Report Date: 06/29/2023
Date Signed: 06/29/2023 03:13:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2023 and conducted by Evaluator Laura Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20230622105118
FACILITY NAME:FUSD - SESPE PRE SCHOOLFACILITY NUMBER:
566215335
ADMINISTRATOR:LORENA RAMOSFACILITY TYPE:
850
ADDRESS:627 SESPE AVETELEPHONE:
(805) 524-8202
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:48CENSUS: 13DATE:
06/29/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lorena RamosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not prevent daycare children from throwing blocks resulting in a daycare child being injured.
INVESTIGATION FINDINGS:
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On June 29, 2023 at 09:30 AM Licensing Program Analyst (LPA) Laura Villanueva made an unannounced inspection to conclude the investigation for the above allegations. LPA met with Program Director, Lorena Ramos and explained the purpose of the visit. LPA conducted a tour of the facility inside and outside. LPA observed a total of 13 children under the care and supervision of 3 staff.

LPA interviewed Program Director, staff, parents, and children. The incident was reported to the Department and a written LIC624 unusual incident/injury report on 6/21//2023. C1 was playing in the block area with 2 other children. S2 advised children that clean up was in 5 minutes. C1 started throwing card board blocks at C2. C2 then threw a wooden block at C1 at close range. C1 sustained a cut to his left cheek. C1 covered his face with his hands. S3 was in the art area adjacent to the block area assisting children with clean up. S2 was walking around the classroom. S3 was the first to tend to C1 when she heard him cry. C1 was taken to the hospital where his cut was glued together. C1 has sustained 2 injuries requiring medical attention while attending preschool.
Continued LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20230622105118
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FUSD - SESPE PRE SCHOOL
FACILITY NUMBER: 566215335
VISIT DATE: 06/29/2023
NARRATIVE
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Based on LPA observations, interviews conducted with staff,parents, children, and documentation, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be SUBSTANTIATED. A type A violation was issued in section Responsibility for care and supervision 101229(a)(1). Deficiency was cited under Title 22 Division 12.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC9099 and LIC9099D.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

Exit interview conducted with Program Administrator. A copy of the Appeal Rights (LIC 9058 FAS 01/16) was given and explained. Program Director's signature on this form acknowledges receipt of these rights. Please refer to LIC9099D for documentation of deficiency cited. A notice of site visit was given.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 17-CC-20230622105118
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FUSD - SESPE PRE SCHOOL
FACILITY NUMBER: 566215335
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/29/2023
Section Cited
HSC
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision- (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the
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An office meeting will be scheduled.
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 supervision of a teacher at any time,..Supervision shall include visual observation. This requirement was not met as evidenced by: A child sustained an injury requiring medical attention. This poses an immediate risk to the health and safety of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3